Mckittrick-wheelock Syndrome Treated By Tem/teo:report of Two Cases

INTRODUCTION The McKittrick-Wheelock syndrome (MW) is characterized by severe dehydration, hyponatremia, hypokaliemia and metabolic acidosis caused by hypersecretant colorectal tumor. We Present two cases of MW treated by TEM/TEO, being the only two published cases by endoscopic endoanal surgery.CLINICAL CASE 1 Women of 64 years, who refers rectal bleeding and deezing. Exploration: pain in right iliac fosse and a rectal polyp 5 cm from anal verge. Blood test: leucocytosis, acute renal failure, hyponatremia and hypokaliemia. Colonoscopy: polypoid lesion that occupied the 80% of the circunference 6 cm from anal verge (Pathologic anatomy (PA): Adenoma with moderate dysplasia). Echoendoscopy: mucosal lesion. TEM was performed and a villous lesion in posterior face was located (PA: Adenoma with moderate dysplasia).12 months later local disease recurrence was observed, and a small polyp lesion 4 cm from anal margin was removed by colonoscopy CLINICAL CASE 2 74 year old man who refers dizziness associated with long standing mucous diarrhea and weight loss. Exploration:hypotension and tumor to 2 cm.from anal margin.Blood test: acute renal failure, hyponatremia, and hypokalemia. Echoendoscopy: mucosal lesion 2 cm of anal verge 10 cm in length that occupied the entire circumference. MRI: 3 cm of the anal margin a polypoid lesion of 8 cm. length. TEO was performed in prone position demonstrating a villous anterior lesion of 3 cuadrants, (PA: Adenoma with moderate dysplasia). No acute surgical complication was observed,being asymptomatic at the present time.DISCUSSION The initial treatment of MW is electrolyte recovery, surgery being the definitive treatment. Indomethacin is recommended prior to surgery. When endoscopic resection is not possible, there are two options: conventional surgery or TEM/TEO, according to location and PA. Although local recurrence, we recommend this surgical approach in cases of appropriate location and PA.

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